BMC primary care最新文献

{"title":"Primary care provider beliefs and knowledge of prescribing gender-affirming hormone therapy to transgender and gender diverse patients.","authors":"Allison T Yip, Stacy Charat, Jordan Silva, Jill Blumenthal","doi":"10.1186/s12875-024-02599-8","DOIUrl":"https://doi.org/10.1186/s12875-024-02599-8","url":null,"abstract":"<p><strong>Background: </strong>Transgender patients often cannot access a provider who is knowledgeable about providing gender-affirming hormone therapy (GAHT). This study evaluated primary care provider (PCP) comfort and experience with, opinions about, and knowledge of prescribing GAHT to adults.</p><p><strong>Methods: </strong>An anonymous Qualtrics survey was distributed to PCPs in San Diego County. Fisher's exact test assessed any association between age, years in practice, or practice setting and 1) comfort in prescribing GAHT and 2) favorable statements about learning about, providing, and benefitting from training in GAHT. T-tests determined relationship between age, years in practice, or practice type setting with number of correctly answered multiple choice knowledge-based questions out of 4.</p><p><strong>Results: </strong>Out of 220 responses, median age was 41, 60% had practiced for ≤ 10 years, and 19% had practiced in an academic setting. Forty-two percent did not receive any education about transgender healthcare during medical training. The most commonly reported barrier to providing GAHT was lack of training (74%). PCPs age ≤ 41 (67% vs 49%, p = 0.009), PCPs practicing for ≤ 10 years (65% vs 51%, p = 0.037), and PCPs in non-academic settings (64% vs. 41%, p = 0.013) were more likely to report being comfortable with prescribing GAHT. PCPs age ≤ 41 (89% vs 62%, p < 0.001) and PCPs practicing for ≤ 10 years (86% vs 66%, p < 0.001) were more likely to show interest in learning about GAHT. PCPs age ≤ 41 (74% vs 46%, p < 0.001) and PCPs practicing for ≤ 10 years (70% vs 50%, p = 0.003) were more likely to show interest in prescribing GAHT. Knowledge scores were higher for PCPs age  ≥42 (mean 1.7 vs 1.4, p = 0.033) and PCPs working in academic centers (mean 2.0 vs 1.4, p = 0.002).</p><p><strong>Conclusion: </strong>Younger (age ≤ 41) and early career (practicing for ≤ 10 years) PCPs reported being more comfortable with prescribing GAHT and had more favorable opinions in learning about, providing, and benefitting from training in GAHT. They are interested in providing GAHT; however, few prescribe GAHT with most reporting lack of training as a major barrier. This was evident with overall low knowledge scores regardless of age, experience, or clinical setting and underscores the need for increased educational efforts in transgender care throughout medical training.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11481314/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge and attitudes about dementia of primary care physicians in Southern Brazil.","authors":"Daiana Perin, Laura Ferraz, Marcelo Rodrigues Gonçalves, Márcia Lorena Fagundes Chaves, Raphael Machado Castilhos","doi":"10.1186/s12875-024-02619-7","DOIUrl":"https://doi.org/10.1186/s12875-024-02619-7","url":null,"abstract":"<p><strong>Background: </strong>Primary Care Physicians have a central role in assisting individuals with dementia and evaluating their preparedness to care these patients is fundamental. Our aim is to evaluate the knowledge and attitudes regarding dementia of the Primary Care Physicians (PCP) in Rio Grande do Sul (RS) state, Southern Brazil.</p><p><strong>Methods: </strong>We collected sociodemographic data, volume of patients with dementia treated/referred and perception of difficulties in caring for these patients. A previously validated questionnaire was sent: \"Quiz on Knowledge and Attitudes in Dementia\".</p><p><strong>Results: </strong>From March/2022 to June/2023, 296 PCP responded to the questionnaire. They were mostly women (52.7%, 156), with a median [IQR] age of 35 [29-44] years, mostly were White (82.1%, 243) and had 7 (4-16) years of experience as a physician. Less than half of the physicians performed cognitive screening (43.9%) and Mini Mental State Examination was the most screening (63.5%) test used. The mean percentage of correct answers in the Knowledge Quiz was 46.4%. In the attitude quiz, we identified 3 factors: 1) frankly positive attitudes; 2) perceive primary care as important but have a pessimistic attitude towards them; 3) see primary care as important for patient care.</p><p><strong>Conclusion: </strong>Knowledge about dementia is low among PCP in RS; however, most have positive attitudes towards these patients or think primary care is important to these patient's care.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11481289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Engaging primary care patients at risk for suicide in mental health treatment: user insights to inform implementation strategy design.","authors":"Courtney Benjamin Wolk, Matteo Pieri, Samantha E Weiss, Joseph Harrison, Gabriela Kattan Khazanov, Molly Candon, David W Oslin, Matthew J Press, Eleanor Anderson, Emilie Famiglio, Alison Buttenheim, Shari Jager-Hyman","doi":"10.1186/s12875-024-02616-w","DOIUrl":"https://doi.org/10.1186/s12875-024-02616-w","url":null,"abstract":"<p><strong>Background: </strong>Given that the majority of suicide decedents visit primary care in the year preceding death, primary care has been identified as a key setting in which to engage patients at risk for suicide in mental health services. The objective of this research was to identify barriers and facilitators to engagement in mental health services among primary care patients at risk for suicide to inform the development of strategies to increase engagement.</p><p><strong>Methods: </strong>Seventy-four semi-structured qualitative interviews were conducted with primary care patients (n = 20), primary care (n = 18) and behavioral health (n = 12) clinicians, mental health intake coordinators (n = 4), and health system and clinic leaders (n = 20). Patients who had been referred for mental health services from primary care and reported an elevated score (≥ 1) on item 9 on the Patient Health Questionnaire at the time of referral were eligible to participate. Eligible clinicians and leaders were employed in a primary care or behavioral health setting in a single large health system with an integrated mental health program. Interviews typically lasted 30-60 min, were completed over video conference or phone, and were coded by members of the research team using a rapid qualitative analysis procedure.</p><p><strong>Results: </strong>Participants were primarily female (64.9%), white (70.3%) and non-Hispanic/Latine (91.9%). The most identified barriers to mental health care engagement were waitlists, capacity limits, insurance, patient characteristics, communication, collaboration, and/or difficulties surrounding travel. The most commonly cited facilitators of engagement included telehealth, integrated care models, reminders, case management support, psychoeducation, motivational enhancement, and scheduling flexibility. Concrete suggestions for improving engagement in mental health services included increasing communication between providers, streamlining referral and intake processes, providing reminders and follow ups, and advocacy for increased reimbursement for suicide risk assessment.</p><p><strong>Conclusions: </strong>Results underscore the myriad barriers patients at risk for suicide encounter when attempting to engage in mental health care in a primary care setting. Facilitators of engagement and suggestions for improving connections to care were also identified, which can inform the design of implementation strategies to improve engagement in mental health services among primary care patients at risk for suicide.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT05021224 (Registered August 19, 2021).</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11481249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Piloting a community health and well-being worker model in Cornwall: a guide for implementation and spread.","authors":"John Tredinnick-Rowe, Richard Byng, Tamsyn Brown, Donna Chapman","doi":"10.1186/s12875-024-02595-y","DOIUrl":"https://doi.org/10.1186/s12875-024-02595-y","url":null,"abstract":"<p><strong>Background: </strong>This paper evaluates the introduction of ten Community Health and Well-being Workers (CHWW) in four pilot sites across Cornwall. The period evaluated was from the initial start in June 2022 until June 2023, covering the project setup and implementation across a range of Primary Care Networks (PCNs) and Voluntary sector partners (VSCO).</p><p><strong>Methods: </strong>All ten CHWWs and their managers at each site were interviewed (n = 16) to understand the barriers and enablers to implementation and wider learning that could be captured around the project setup. Qualitative methods were used for data collection, including semi-structured interviews and focus groups. Transcripts were thematically analysed for cross-cutting themes, as well as site-specific effects.</p><p><strong>Results: </strong>In terms of learning, we cover the following key areas, which were of most importance to the successful implementation of the pilot: The CHWWs were introduced into an already established, successful social prescribing (SP) system by the time the CHWW project began. CHWWs can access some of the same training and office space as SPs, with overlapping meeting schedules allowing them joint input on some topics. It seemed that all the pre-work in terms of relationships and learning about a similar role helped a rapid implementation. Each site's CHWW management structure uses the same line management as the SPs. Roles were clustered together to remove duplication, maximise coverage and triaging of residents. The largest barrier to overcome was integrating VSCO staff into NHS systems. Conversely, hosting CHWWs within an NHS organisation has pros and cons, namely better access to NHS data and staff, but longer lead-in time for registration on systems, and more bureaucracy for procurement/spend.</p><p><strong>Conclusions: </strong>Looking to the future, the pilot's success has spread the programme to other integrated care areas in the country, with ongoing plans for further rollout and evaluation in the coming years.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11476637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Referral pathway and competency profiles of primary care physiotherapists and kinesiologists for physical activity interventions for diabetes: a modified Delphi study.","authors":"Carly Proctor, Cara L Brown","doi":"10.1186/s12875-024-02611-1","DOIUrl":"https://doi.org/10.1186/s12875-024-02611-1","url":null,"abstract":"<p><strong>Background: </strong>High quality diabetes care is an essential service in primary care settings since the prevalence and associated complications of diabetes is increasing. Physical activity is effective for the prevention and management of diabetes yet is underutilized in diabetes care. Exercise professionals have specialized skills to deliver physical activity interventions, but effective interprofessional collaboration for diabetes care requires role clarity. This study established the competencies of entry-level physiotherapists and kinesiologists for physical activity interventions for diabetes care in primary care settings and used these competencies to develop clinical tools to promote role clarity in interprofessional care teams.</p><p><strong>Methods: </strong>We used a modified Delphi process. Eleven physiotherapy and three kinesiology subject matter experts participated in two rounds of Delphi surveys to develop discipline and context specific competencies. These competencies were used to draft competency profiles and a referral pathway tool. Eleven of the participants then participated in a focus group for member-checking of the tools. Descriptive statistics and content analysis were used to analyze quantitative and qualitative data respectively.</p><p><strong>Results: </strong>The modified Delphi process resulted in 38 physiotherapy and 27 kinesiology competencies that identify the distinct roles of physiotherapists and kinesiologists in delivering physical activity interventions for diabetes care. The physiotherapy competencies describes their unique role in supporting people with all types of diabetes to engage in physical activity despite complex medical or physical barriers. The kinesiology competencies indicate where these professionals may require additional training, especially when working with people living with type 1 diabetes or who are pregnant. All developed tools had good face validity and were seen to be potentially useful tools by the subject matter experts.</p><p><strong>Conclusions: </strong>The findings highlight that both physiotherapists and kinesiologists have fundamental skills and abilities to deliver physical activity interventions to people living with diabetes, but that different exercise professionals may be needed depending on the complexity of the clinical profile. The developed clinical tools support improved interprofessional collaboration by clarifying physiotherapy and kinesiology roles in delivering physical activity interventions for diabetes care and highlighting how the two distinct professions can contribute to addressing the growing diabetes epidemic in primary care.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11479570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acceptability and use of HIV self-testing among young people in sub-Saharan Africa: a mixed methods systematic review.","authors":"Eshetu Andarge Zeleke, Jacqueline H Stephens, Hailay Abrha Gesesew, Behailu Merdekios Gello, Anna Ziersch","doi":"10.1186/s12875-024-02612-0","DOIUrl":"https://doi.org/10.1186/s12875-024-02612-0","url":null,"abstract":"<p><strong>Background: </strong>Young people (YP) are disproportionately affected by the HIV pandemic in sub-Saharan Africa (SSA), but testing rates remain low despite global targets of testing 95% of people with HIV infection by 2030. HIV self-testing (HIVST) has been recently introduced to reach high-risk population groups such as these. Thus, synthesis of emerging evidence on the acceptability and use of HIVST among YP in SSA is needed so that comprehensive information can be generated to inform policy and practice.</p><p><strong>Methods: </strong>We employed a mixed methods systematic review of quantitative and qualitative literature reporting on HIVST among YP involving any design and published in English by 31st of October 2023. The review synthesized quantitative evidence on acceptability and use of HIVST, and qualitative evidence on perspectives of YP about HIVST. We searched databases of published articles (e.g. MEDLINE, CINAHL) and Gray literature sources (e.g. Google, Google Scholar). The concepts for the search included self-testing, HIV/AIDS, and countries in SSA. Two authors independently screened, retrieved full-text, and assessed quality of the studies.</p><p><strong>Results: </strong>A total of 4150 studies were retrieved and 32 studies were finally included in the review. Acceptability of HIVST computed from a single item asking YP on their preference or willingness or demand for HIVST was moderate (34-67%) to high (≥ 67%) among YP in SSA. Nine of the fourteen studies that reported on acceptability found high acceptability of HIVST. Use of HIVST ranged from 0.8 to 100% while in most studies the use rate was below 50%. Key barriers to HIVST use were coping with a positive test in the absence of counselling and support, physical discomfort, and cost of kits. Perceived enablers included perceptions of HIVST as promoting personal empowerment and autonomy; privacy and confidentiality; and convenience in location, time, and skill.</p><p><strong>Conclusions: </strong>HIVST was highly accepted but not well utilized among YP in SSA. YP showed diversified needs with mixed preferences for location, and modalities of service provision. Overall, the review identified heterogeneous evidence in terms of methods, population, outcome measures, and results. The review was registered in the International Prospective Registry of Systematic Reviews (PROSPERO: ID = CRD42021278919).</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11475945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploration of primary care models and timely access to care in New Brunswick (Canada).","authors":"Claire Johnson, Dominique Bourgoin, Jérémie B Dupuis, Jenny Manuèle Félix, Véronique LeBlanc, Danielle McLennan, Luveberthe St-Louis","doi":"10.1186/s12875-024-02618-8","DOIUrl":"https://doi.org/10.1186/s12875-024-02618-8","url":null,"abstract":"<p><strong>Background: </strong>This correlative study aimed to examine how the different primary care models (physicians in solo practice, physicians in collaborative practice, physicians and nurse practitioners in collaborative practice, after-hours clinics, community centers, or emergency rooms) were associated with their capability to offer timely access to their patients. The data collected from the primary care provider's perspective was to complete the New Brunswick Health Council results on patients' perspective.</p><p><strong>Methods: </strong>A convenience sample of 120 primary care providers (33 physicians in solo practice, 33 physicians in collaborative practice, 27 providers in collaborative practice with nurse practitioners, 2 providers working in after-hours clinics, and 10 providers in Emergency departments) responded to an online survey about their primary care models and accessibility. We used the Statistical Package for Social Sciences software to run correlations, independent t-tests and Fisher's exact tests to compare timely access to care between variable groups.</p><p><strong>Results: </strong>A positive correlation was observed between patient load (or the number of patients under a primary care provider's practice), age and years of experience. However, the patient load did not translate to more timely access to care. However, a statistically significant difference (p = 0.032) was observed when primary care providers kept appointment slots available for daily urgent requests. When a primary care provider booked all available appointment slots, only 85% of them could offer timely appointments (in 5 days or less), compared to 97% who could deliver it when appointment slots were left open in their daily schedule. The primary care model (solo vs. collaboration), the use of health technologies and the type of provider did not significantly influence timely access to care. In contrast, the primary care providers who reported teleworking (or working remotely) were less likely to offer timely access to care.</p><p><strong>Conclusion: </strong>Timely access to care is not always available to patients, even those with a primary care provider. Certain organizational practices may improve access to care and should be integrated into primary care in New Brunswick and elsewhere in Canada.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11472562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-cultural adaptation of the Quebecois Patient-Centered Coordination by a Care Team Questionnaire for use in France.","authors":"Arthur Piraux, Marie-Eve Poitras, Sandra Lemarchand, Stephanie Sidorkiewicz, Aline Ramond-Roquin","doi":"10.1186/s12875-024-02606-y","DOIUrl":"https://doi.org/10.1186/s12875-024-02606-y","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of chronic disease and multimorbidity is increasing and the associated disease and treatment burden is particularly heavy. Coordinated multidisciplinary, patient-centered care is particularly important for people living with chronic disease or multimorbidity. There was no valid tool to measure the quality of coordinated patient-centered care from the patient's perspective until the Patient-Centered Coordination by a Care Team (PCCCT) questionnaire was recently developed in Canada (Quebec/Ontario). The Quebecois version has been validated but is not directly transferable to France due to linguistic, cultural and health system differences between the two countries. To perform a cross-cultural adaptation of the Quebecois PCCCT questionnaire is therefore necessary to obtain a questionnaire's new version adapted for use in France, ensuring item and semantic equivalence.</p><p><strong>Methods: </strong>The adaptation process consisted of two stages, both of which were supervised by a scientific committee made up of five healthcare professionals. The first stage was a Delphi consensus involving a multidisciplinary healthcare professional panel to evaluate and harmonize the clarity and appropriateness of the questionnaire for patients in the French health system. During the second stage, adult patients with one or more chronic diseases, from various age, sex, socio-occupational categories, assessed the comprehensibility and conformity of the adapted version of the questionnaire resulting from stage 1 and improved it if necessary. This was achieved using cognitive interviews.</p><p><strong>Results: </strong>During Stage 1, two rounds were undertaken with 10 professional experts resulting in consensual reformulation of 10 out of the 14 items. These newly formulated items and the 4 remaining items were submitted to patients in Stage 2. Cognitive interviews were undertaken with 14 patients, testing 3 successively adapted versions of the questionnaire, until three consecutive patients did not find any ambiguity or misunderstanding. The final version resulting from the cross-cultural adaptation process aimed at being used in France, has item and semantic equivalence to the original Quebecois version.</p><p><strong>Conclusions: </strong>Measurement equivalence will be addressed in a future study. This French version is intended to be a useful resource for the health system reforms aimed at promoting more integrated and patient-centered care pathways.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11471038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge, attitude, and practice of chronic insomnia management among general practitioners in China: a cross-sectional survey.","authors":"Kang An, Zengxiang Wu, Lin Zhang, Yuqi Li, Zhenmei An, Shuangqing Li","doi":"10.1186/s12875-024-02615-x","DOIUrl":"https://doi.org/10.1186/s12875-024-02615-x","url":null,"abstract":"<p><strong>Background: </strong>Chronic insomnia is a common yet often overlooked issue in primary health care. This study investigated the knowledge, attitude, and practices of chronic insomnia management among general practitioners (GPs).</p><p><strong>Methods: </strong>A cross-sectional online survey was conducted among GPs providing routine care to adults with insomnia in health facilities at all levels in Sichuan Province, China. Additionally, we designed an online questionnaire that included basic information and knowledge, attitudes, and practices regarding chronic insomnia management.</p><p><strong>Results: </strong>We included 420 GPs, 66.2% of whom were female and 58.1% were from community health service centers. Total 198 (47.1%) GPs had received specific training and only 2 GPs (0.5%) correctly answered the knowledge-related questions. Furthermore, only 44 GPs (10.5%) demonstrated excellent practice behaviors, while most GPs (70.2%) expressed high demand for training in insomnia management. Insomnia training experience was associated with higher practice scores (β = 3.318, p < 0.001).</p><p><strong>Conclusion: </strong>This study established an association and correlation between knowledge, attitude, and practice scores in treating insomnia and the sociodemographic characteristics of GPs in China. Although knowledge and practice performance in this field need to be improved, they mostly displayed a positive attitude towards insomnia management. Thus, offering continuing education opportunities to GPs would be highly beneficial.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11475601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Organizational innovations related to Primary Care Access Points (GAP) for unattached patients in Quebec: a multi-case qualitative study.","authors":"Mylaine Breton, Véronique Deslauriers, Catherine Lamoureux-Lamarche, Mélanie Ann Smithman, Carine Sauvé, Marie Beauséjour, Maude Laberge, Aude Motulsky, Marie-Pascale Pomey","doi":"10.1186/s12875-024-02614-y","DOIUrl":"https://doi.org/10.1186/s12875-024-02614-y","url":null,"abstract":"<p><strong>Background: </strong>Being attached to a primary care (PC) provider is at the core of a strong primary health care system. Centralized waiting lists (CWL) for unattached patients have been implemented in eight provinces of Canada to support the attachment process. In Quebec, the Ministry of Health mandated the implementation of Primary Care Access Points (GAP) across the province to help unattached patients navigate the health system while awaiting attachment through the CWL. Several local health territories developed complementary innovations to the GAP to respond to local population needs. This paper aims to describe five organizational innovations implemented locally.</p><p><strong>Methods: </strong>This multi-case qualitative study was conducted in four local health territories in the province of Quebec. Fifty-two semi-structured interviews with healthcare managers, nurses, physicians, other health professionals and administrative staff were conducted between April 2023 and April 2024. An interview guide was developed based on existing frameworks on the implementation of innovations and the evaluation of the GAP. Thematic analysis was conducted using NVivo software. Inductive and deductive approaches were used to develop relevant codes and themes. Logic models were built to describe the organizational innovations.</p><p><strong>Results: </strong>Five organizational innovations are described. First, a multidisciplinary clinic aimed at responding to patients with mental health issues was implemented. Second, a nurse clinic was implemented to provide temporary care for patients with unstable chronic illnesses. The third innovation is a mobile proximity clinic where unattached GAP patients are first evaluated by a paramedic before receiving care from a nurse. Fourth, a pharmacist trajectory was implemented to increase engagement of community pharmacists to respond to GAP patients. The last innovation is a decentralized GAP offering in-person nursing care to unattached GAP patients.</p><p><strong>Conclusions: </strong>Descriptions of these five innovations are key to inform other territories and provinces on ways to improve access for unattached patients while they are waiting to be attached. The introduction of the GAP and the organizational innovations, suggests a transition where access to PC services does not rely solely on attachment status.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11475358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}